Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213707 DEA: 081C38U4 EFIS: 0817000196
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-6.7/R25.1
Work Description: Remove concrete pavement and base, and place HMA and JPCP
Location Description: ROUTE 10/60 SEPARATION IN BEAUMONT TO ROUTE 10/111 SEPARATION NEAR CABAZON.
Contractor Name: Coffman Specialties
Contractor Address: 9685 Via Excelencia, San Diego, CA 92126
Resident Engineer: Elvira Lenart Structure Rep.: Unknown
DIME Sample ID: 2020-06-25-27
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/25/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/29/2020
The quantity of what the sample constitutes: 884 Tons
A brief description of the sample: 3/4" HMA-A R24 PG64-28M (0.50% LAS)
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CCA-Coachella
